Carpal tunnel syndrome is characterized by non-inflammatory fibrosis of the subsynovial connective tissue next to the tendons in the carpal tunnel, suggesting a shear injury owing to repetitive wrist and finger motion at work. I tested the effects of several well-established biomechanical predictors of injury on tendon and subsynovial connective tissue motion and shear in the carpal tunnel. These included non-neutral finger and wrist posture, speed of work, and forceful exertion. A cadaveric paradigm was used to directly measure tendon gliding characteristics, which showed that concurrent exposure to multiple biomechanical risk factors disproportionately increased tendon frictional work (Chapter 2). Given that tendon shear cannot be directly measured in vivo, colour flow ultrasound was used to assess relative motion between tendon and subsynovial connective tissue as a metric of shear potential (Chapter 3 − 5). Healthy participants completed middle finger movements while colour flow ultrasound imaged carpal tunnel structures and optical motion capture recorded finger joint kinematics. From the data, I developed regression equations to predict both tendon and subsynovial connective tissue displacements as a function of finger joint angles, which can be used as an ergonomic method to calculate the relative displacement (Chapter 3). Furthermore, relative motion between tendon and subsynovial connective tissue increased with wrist flexion angle, suggesting a greater susceptibility to shear injury during repetitive work when the wrist is flexed (Chapter 4). Using colour flow imaging, electrogoniometry, and fine-wire EMG, relative displacement was found to increase with tendon velocity and force (Chapter 5). Relative displacements in Chapters 3 to 5 were combined into a prediction model, and further compared to a tendon friction model derived from Chapter 2. The relative displacement model showed an additive relationship with combined physical exposures, including finger and wrist position, tendon velocity, and force (Chapter 6). The relative displacement model was more responsive to lower physical exposures whereas the friction model produced greater overall changes (with higher exposures). While both models infer a greater risk of shear injury due to repetitive and forceful wrist/finger movement, future studies will aim to set protective guidelines based on tendon motion and shear during hand-intensive work. Overall, this thesis showed that tendon friction and relative motion between tendon and subsynovial connective tissue both increased in response to well-established biomechanical risk factors. We propose the current models for use in ergonomics, representing a move towards mechanistic-based injury risk assessment of the wrist and hand. / Thesis / Doctor of Philosophy (PhD)

<p>The purpose of this thesis was to evaluate musculoskeletal contributions to joint stiffness in the distal upper extremity. An <em>in-vitro</em> and <em>in-vivo</em> approach was used to examine muscle and ligament contributions to mechanical joint stiffness at the elbow and wrist. In Chapters 2 and 3 an <em>in-vitro</em> approach was used to evaluate ligament contributions to carpal tunnel mechanics. Chapter 2 documented transverse carpal ligament (TCL) mechanical properties and provided a calculation of TCL length when stretched, which confirmed the ligaments importance in carpal tunnel mechanics and carpal bone stability. Chapter 3 quantified mechanical properties of the TCL at six different locations using a biaxial tensile testing method. It was found that the complex TCL fibre arrangement makes the tissue properties location dependent. The TCL contributes to carpal tunnel mechanics and carpal stability and the ligament contributions are different depending on the tissue location tested. Chapters 4 and 5 focused on the effects of hand loads and arm postures on the muscular response to sudden arm perturbations. The elbow flexors demonstrated stiffness contributions immediately prior to a perturbation and were influenced by posture and hand loading. The forearm muscles provided a small contribution to elbow joint stiffness. Chapter 6 also found muscular contributions that increased wrist joint stiffness immediately prior to a sudden perturbation. Additionally, for a small grip-demanding task, forearm muscle co-contraction resulted in large increases in wrist joint stiffness.</p> <p>This thesis has provided a detailed analysis of the TCL which improves our understanding of the carpal tunnel and specific mechanisms of injury. It is the first to document individual muscle contributions to elbow and wrist joint stiffness. The comprehensive analysis of ligament and muscular contributions to joint stiffness has provided insight into joint stability in the distal upper extremity. This can improve our understanding of injury caused by sudden joint loading.</p> / Doctor of Philosophy (PhD)

A Biomecânica Ocupacional procura aprimorar as condições de trabalho objetivando prevenir e reduzir as lesões, aumentar o desempenho dos operários reduzindo sobrecargas. Pesquisas nesta área indicam que não apenas a manipulação de materiais pesados, mas também posturas pouco naturais e movimentos súbitos e inesperados provocam lesões no sistema osteomuscular que afetam principalmente o pescoço, membros superiores e região lombar. Alguns profissionais apresentam alto risco ao aparecimento desses distúrbios envolvendo principalmente os membros superiores e região lombar, particularmente os digitadores, operadores de caixa de supermercados, dentistas, motoristas profissionais e operadores de trens metropolitanos. Este estudo teve como objetivo estimar a carga mecânica e a atividade muscular no membro superior esquerdo de maquinistas condutores de trens metropolitanos durante o trabalho. Especificamente, o estudo procurou estimar a carga mecânica sobre a articulação do ombro, avaliar a atividade muscular dos músculos tríceps e flexores do punho e verificar a ocorrência de fadiga muscular durante a realização da tarefa, para isto foram investigados o fator de risco relacionado a enfermidades dos membros superiores, o torque sobre a articulação do ombro e a freqüência mediana do sinal eletromiográfico. O método RULA indicou para atividade estudada um escore final quatro, que sugere mais investigações e mudanças podem ser requeridas, pois a postura adotada gera desconforto. O torque calculado sobre a articulação do ombro é aplicado por cerca da metade da jornada de trabalho e apresentou valor médio de -4,1 Nm com o manete na posição 0. A instauração de fadiga sobre os músculos Tríceps Braquial e flexores do punho não foi observada. Estudos futuros são recomendados para desenvolvimento de cabinas de trens metropolitanos com layout ergonômico e posicionamento de instrumentos que possibilite uma postura mais adequada dos operadores / Occupational biomechanics seeks to improve the conditions of work aiming to prevent and to reduce the injuries, to increase the performance of workers reducing overloads. Previous researches in this area indicate that not only handling the of heavy material, inadequate postures and unexpected and sudden movements provoke injuries in the musculoskeletal system that affect mainly the neck, upper limbs and the lumbar region. Some workers present high risk to the develop those disturbances involving mainly the upper limbs and the lumbar region, particularly the keyboarders, supermarket cashiers, dentists, professional drivers and operators metropolitan train. This study aimed to estimate the mechanical load and the muscular activity in the left upper limb of metropolitan train drivers during the work. Specifically, the study sought to estimate the mechanical load on the joint of the shoulder, evaluate the muscular activity of the muscles triceps and flexors of the wrist and verify the occurrence of muscular fatigue during the achievement of the task. For this purpose, it were investigated the risk factor related to the diseases of the upper limbs, the torque on the joint of the shoulder and the median frequency of the electromyographic signal. The method RULA indicated for activity a score final four, which suggests more investigations and changes may be required because the usual posture adopted generates discomfort. The calculated torque on the joint of the shoulder is applied by about half of the day at work and showed the average value of -4.1 Nm with the handle in position 0. The instauration of fatigue on the muscles Tríceps brachial the wrist flexor was not observed. Thus, future studies are recommended to the development of the metropolitan trains\' berths with ergonomic layout and positioning of instruments that enables an adequate posture of its users

A Biomecânica Ocupacional procura aprimorar as condições de trabalho objetivando prevenir e reduzir as lesões, aumentar o desempenho dos operários reduzindo sobrecargas. Pesquisas nesta área indicam que não apenas a manipulação de materiais pesados, mas também posturas pouco naturais e movimentos súbitos e inesperados provocam lesões no sistema osteomuscular que afetam principalmente o pescoço, membros superiores e região lombar. Alguns profissionais apresentam alto risco ao aparecimento desses distúrbios envolvendo principalmente os membros superiores e região lombar, particularmente os digitadores, operadores de caixa de supermercados, dentistas, motoristas profissionais e operadores de trens metropolitanos. Este estudo teve como objetivo estimar a carga mecânica e a atividade muscular no membro superior esquerdo de maquinistas condutores de trens metropolitanos durante o trabalho. Especificamente, o estudo procurou estimar a carga mecânica sobre a articulação do ombro, avaliar a atividade muscular dos músculos tríceps e flexores do punho e verificar a ocorrência de fadiga muscular durante a realização da tarefa, para isto foram investigados o fator de risco relacionado a enfermidades dos membros superiores, o torque sobre a articulação do ombro e a freqüência mediana do sinal eletromiográfico. O método RULA indicou para atividade estudada um escore final quatro, que sugere mais investigações e mudanças podem ser requeridas, pois a postura adotada gera desconforto. O torque calculado sobre a articulação do ombro é aplicado por cerca da metade da jornada de trabalho e apresentou valor médio de -4,1 Nm com o manete na posição 0. A instauração de fadiga sobre os músculos Tríceps Braquial e flexores do punho não foi observada. Estudos futuros são recomendados para desenvolvimento de cabinas de trens metropolitanos com layout ergonômico e posicionamento de instrumentos que possibilite uma postura mais adequada dos operadores / Occupational biomechanics seeks to improve the conditions of work aiming to prevent and to reduce the injuries, to increase the performance of workers reducing overloads. Previous researches in this area indicate that not only handling the of heavy material, inadequate postures and unexpected and sudden movements provoke injuries in the musculoskeletal system that affect mainly the neck, upper limbs and the lumbar region. Some workers present high risk to the develop those disturbances involving mainly the upper limbs and the lumbar region, particularly the keyboarders, supermarket cashiers, dentists, professional drivers and operators metropolitan train. This study aimed to estimate the mechanical load and the muscular activity in the left upper limb of metropolitan train drivers during the work. Specifically, the study sought to estimate the mechanical load on the joint of the shoulder, evaluate the muscular activity of the muscles triceps and flexors of the wrist and verify the occurrence of muscular fatigue during the achievement of the task. For this purpose, it were investigated the risk factor related to the diseases of the upper limbs, the torque on the joint of the shoulder and the median frequency of the electromyographic signal. The method RULA indicated for activity a score final four, which suggests more investigations and changes may be required because the usual posture adopted generates discomfort. The calculated torque on the joint of the shoulder is applied by about half of the day at work and showed the average value of -4.1 Nm with the handle in position 0. The instauration of fatigue on the muscles Tríceps brachial the wrist flexor was not observed. Thus, future studies are recommended to the development of the metropolitan trains\' berths with ergonomic layout and positioning of instruments that enables an adequate posture of its users

Introduction: External support behaviours, which include leaning (supporting with the non-task hand) or bracing (supporting with the body), are frequently employed by workers in manufacturing settings. However, current ergonomic assessment tools are limited by our limited understanding of these behaviours. Recent studies have investigated these behaviours, however, the designs of these studies are limited in their applicability to real-world scenarios. The purpose of this study was to assess how different task parameters affect the prediction of external support behaviours, as well as the effect of support on task hand, and body, kinematics and kinetics, in a minimally constrained experimental design. Methods: Female participants (n = 18) performed a series of one-handed maximal exertions (in the six orthogonal directions), and one precision task, in four hand Locations. Trials either featured support (as chosen by the participant), or no support. Results & Discussion: Three logistic regression models were developed, with inputs from individual and task characteristics, and they correctly predicted the occurrence of leaning, bracing, or simultaneous leaning and bracing, 74-86% of the time. Leaning and/or bracing were found to provide: 1) oppositional forces to increase task hand force generation, 2) balance, by countering destabilizing moments about the feet, and 3) a reduction in moment arm of the task hand force, with respect to the upper body joints, by bringing the shoulder closer to the task hand. Participants were able to exert 64.8% more force at the task hand as a result of support. Leaning hand placement depended on the task force direction and location. However, the positioning of the leaning hand varied very little. Finally, the precision condition showed that fine motor demands may also affect external support choice. / Thesis / Master of Science in Kinesiology